Home
About
Services
Core Services
PEO Services
Group 401K Plan
AllOne Employee Assistance Program
AblePay Discounts
Resources
2021 Independence Blue Cross
2020 Independence Blue Cross
AblePay Discounts
Insurance for Kids
Plan Comparison
Blog
Reimbursing Individual Health Insurance Premiums
New to Group Health Insurance? What to Expect.
Medicare Secondary Payer (MSP) Employer Surveys
How to Calculate Payroll Deductions
The Power of Pre-Tax Deductions
How to Shop for Health Insurance
How Dental Insurance Really Works
Insurance Costs & Networks
Contact / Enroll
Enrollment
Request A Quote
Quote
Company Name:
Company name
Field is required!
Field is required!
Legal Tax Class
- select a option -
C-Corp
S-Corp
LLC or LLP
Sole Proprietor
Non-Profit 501(c)(3)
Other / I don't know
- select a option -
Field is required!
Field is required!
Company EIN:
Tax ID for the company
Field is required!
Field is required!
Number of Employees:
Total full time employee headcount
Field is required!
Field is required!
Company Address:
Company's Legal Address
Field is required!
Field is required!
City:
City
Field is required!
Field is required!
State:
- select a state -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
- select a state -
Field is required!
Field is required!
Zip Code:
Zip Code
Field is required!
Field is required!
Your Name:
Your Name
Field is required!
Field is required!
Your Email Address:
Your E-mail Address
Field is required!
Field is required!
Your Phone Number:
Your Phone Number
Field is required!
Field is required!
Kind of Quote Requested
Health Insurance
Dental Insurance
Disability Insurance
401K Plan
Payroll or HR Services
Field is required!
Field is required!
Does the Company have a GROUP health plan right now?
Yes
No
Field is required!
Field is required!
Current GROUP Health Insurance Carrier:
Name of health insurance company
Field is required!
Field is required!
[{"field":"current_health_plan","logic":"equal","value":"yes","and_method":"","field_and":"","logic_and":"","value_and":""}]
Name(s) of Health Plans Offered:
Name of the insurance plan people enroll into
Field is required!
Field is required!
[{"field":"{current_health_plan}","logic":"equal","value":"Yes","and_method":"","field_and":"","logic_and":"","value_and":""}]
Amount Company Pays Towards Health Insurance:
This is usually a flat dollar amount or percentage of premium
Field is required!
Field is required!
[{"field":"current_health_plan","logic":"equal","value":"Yes","and_method":"","field_and":"","logic_and":"","value_and":""}]
[{"field":"{quote}","logic":"contains","value":"Health Insurance","and_method":"","field_and":"","logic_and":"","value_and":""}]
Does the Company have a GROUP disability plan right now?
Yes
No
Field is required!
Field is required!
Will Company pay towards disability coverage?
Yes
No
Field is required!
Field is required!
Census Instructions:
Please upload a document with each employee's date of birth (or age), gender, tobacco smoking status (i.e. do they smoke?), home zip code, and estimated annual salary
Field is required!
Field is required!
Census Upload
Upload your documents...
Field is required!
Field is required!
[{"field":"{quote}","logic":"contains","value":"Disability Insurance","and_method":"","field_and":"","logic_and":"","value_and":""}]
Submit
INTERESTED?
PLEASE
CONTACT US
